Open Perilunate Fracture Dislocation with Lunate Extrusion: A Case Report and Literature Review

Perilunate injuries with lunate extrusion are extremely rare, representing an extreme subgroup of the Mayfield type 4 spectrum, with prognosis and management remaining controversial. We present a 45-year-old man with an open type 4 perilunate fracture dislocation, with lunate extrusion through the volar skin. Despite emergent treatment with open reduction and internal fixation, lunate and scaphoid proximal pole avascular necrosis developed. However, the overall functional outcome was satisfactory for daily activities at 30 months follow-up, with substantial improvement in the range of motion after hardware removal. To our knowledge, this is the third reported case of an open perilunate injury with lunate extrusion in the literature.

Trans-scaphoid Perilunate Fracture Dislocation

Trans-scaphoid perilunate fracture dislocations, which account for more than half of total cases of perilunate injuries, are common in young patients and occur as a result of high-energy injuries, and improper management can impair wrist alignment and function. Understanding the related wrist anatomy and pathomechanics may help surgeons evaluate and diagnose patients. Early operation to reduce and fix the injuries should be considered to achieve optimal clinical and radiological outcomes. In this review article, we present an overview of wrist pathoanatomy, the pathomechanics of trans-scaphoid perilunate fracture dislocations, operative treatment options including an arthroscopic procedure, and reported clinical and radiological outcomes.

Avascular necrosis of the lunate secondary to perilunate fracture dislocation: Case report and review of the literature

This is a 39-year-old male, fell from a bike, left wrist with trans-styloid perilunate fracture dislocation that underwent open reduction internal fixation, 20 months after surgery the patient developed avascular necrosis of the lunate, final wrist fusion was performed secondary to the arthritic changes on the wrist. Anatomic dissection was performed and vascularity of the lunate was identified, its origin is from the volar palmar arch, when dislocated palmarly and more than 90 degrees the vessel is still intact. More than 512 patients with perilunate dislocation and perilunate fracture dislocation are included we identified in the literature transient avascular necrosis of the lunate in nine and seventeen of pure avascular necrosis of the lunate. Concluding that avascular necrosis of the lunate after perilunate dislocation or perilunate fracture dislocation is an infrequent finding especially when the volar ligaments are intact.

Fivefold Fracture in a Perilunate Fracture Dislocation Involving Scaphoid, Capitate, Hamate, Triquetrum and Lunate: A Case Report

This case report presents a very rare fracture combination in a perilunate dislocation including the scaphoid, capitate, hamate and triquetrum and the cornu anterior of the lunate, with an intact scapholunate ligament in a left wrist. An open reduction and internal fixation of the scaphoid, capitate, hamate and triquetrum was performed.